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Clinical exam things > Neurology exam > Flashcards

Neurology exam Flashcards

1
Q

Causes of Horner’s syndrome

A 
Carcinoma of lung apex- squamous cell
Thyroid malignancy, trauma
Carotid aneurysm/dissection
Brainstem lesion- vascular disease, tumour
Retro-orbital lesion
Syringomyelia
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2
Q

One-and-a-half syndrome

A

Horizontal gaze palsy when looking to 1 side
Impaired adduction on looking to other side
Exotropia (turning out) of eye opposite side of lesion
Causes- stroke, plaque of MS, tumour in dorsal pons
When combined with lesion of ipsilateral facial nerve causing LMN weakness –> eight-and-a-half syndrome

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3
Q

If suspecting Horner’s syndrome (partial ptosis + miosis)

A
  1. Test for anhydrosis
  2. Exclude lateral medullary syndrome - nystagmus, ipsilateral CN V, IX and X, ipsilateral cerebellar signs, contralateral pain and temp loss over trunk/limbs
  3. Check for hoarse voice, clubbing and finger abduction for C8/T1 lesion
    - -> perform respiratory exam if signs present
  4. Examine neck for lymphadenopathy, thyroid carcinoma, carotid aneurysm/bruit
  5. Check for dissociated sensory loss for syringomyelia
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4
Q

Causes of anosmia (CN I)

A

Bilateral- URTI, meningioma of olfactory groove, ethmoid tumours, head trauma, meningitis, hydrocephalus, Kallmann’s syndrome, COVID

Unilateral- meningioma of olfactory groove, head trauma

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5
Q

Light reflex

A

Via optic nerve and tract (no cortical involvement)

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6
Q

Accommodation reflex

A

Originates in cortex, associated with convergence

Relayed via parasympathetic fibres in CN III

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7
Q

Causes of absent light reflex but intact accommodation reflex

A

Midbrain lesion- Argyll Robertson pupil
Ciliary ganglion lesion- Adie’s pupil
Parinaud’s syndrome
Bilateral anterior visual pathway lesion

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8
Q

Causes of absent convergence but intact light reflex

A

Cortical lesion

Midbrain lesion

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9
Q

Causes of pupil constriction

A 
Horner's syndrome
Argyll Robertson pupil
Pontine lesion
Narcotics
Pilocarpine drops
Old age
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10
Q

Causes of pupil dilatation

A 
Mydriatics, atropine poisoning, cocaine
3rd nerve lesion 
Adie's pupil
Iridectomy, iritis
Post-trauma
Cerebral death
Congenital
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11
Q

Tunnel vision

A

Glaucoma

Papilloedema

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12
Q

Enlarged blind spot

A

Optic nerve head enlargement

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13
Q

Central scotomata

A

Optic nerve head to chiasmal lesion- demyelination, toxic, vascular

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14
Q

Unilateral field loss

A

Optic nerve lesion- vascular, tumour
Retinal vein occlusion

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15
Q

Bitemporal hemianopia

A

Optic chiasma lesion- pituitary tumour, sella meningioma

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16
Q

Homonymous hemianopia

A

Optic tract to occipital cortex

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17
Q

Upper quadrant (superior) homonymous hemianopia

A

Temporal lobe lesion (PITS)

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18
Q

Lower quadrant (inferior) homonymous hemianopia

A

Parietal lobe lesion (PITS)

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19
Q

Adie’s syndrome

A

Lesion in efferent parasympathetic pathway

  • Dilated pupil
  • Decreased/absent reaction to light (direct and consensual)
  • Slow/incomplete reaction to accommodation
  • Decreased tendon reflexes

Typically young women

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20
Q

Argyll Robertson pupil

A

Lesion of iridodilator fibres in midbrain
Causes- syphilis, DM, alcoholic midbrain degeneration
Features- small irregular pupil, no reaction to light, prompt reaction to accommodation, decreased reflexes (if associated with tabes)

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21
Q

Papilloedema

A 
Optic disc swollen without venous pulsation
Normal early acuity and colour vision
Large blind spot
Peripheral constriction of visual fields
Usually bilateral

Causes- space-occupying lesion, hydrocephalus, idiopathic intracranial HTN, HTN grave IV, central retinal vein thrombosis, cerebral venous sinus thrombosis, high CSF protein level (GBS)

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22
Q

Causes of optic atrophy

A 
Chronic papilloedema or optic neuritis
Optic nerve pressure/division
Glaucoma
Ischaemia
Familial- Friedreich's ataxia, retinitis pigmentosa
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23
Q

Causes of optic neuropathy

A 
MS
Toxic- ethambutol, chloroquine, nicotine, alcohol
Metabolic- vitamin B12 deficiency
Ischaemia- DM, atheroma
Familial- Leber's disease
Infectious mononucleosis
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24
Q

Causes of cataract

A 
Old age 
Endocrine- DM, steroids
Hereditary- myotonic dystrophy
Glaucoma
Irradiation 
Trauma
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25
Q

Causes of ptosis

A

Normal pupils- senile ptosis, myotonic dystrophy, facioscapulohumeral dystrophy, ocular myopathy, thyrotoxic myopathy, myasthenia gravis, botulism, congenital, fatigue

Constricted pupils- Horner’s syndrome, tabes dorsalis

Dilated pupils- 3rd nerve lesion

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26
Q

3rd nerve palsy

A

Dilated pupil unreactive to light or accommodation
Complete ptosis
Divergent strabismus- ‘down and out’

Causes- central (vascular, tumour, demyelination, trauma), peripheral (compressive lesion eg. PICA aneurysm, infarction, cavernous sinus lesion)

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27
Q

CN III (oculomotor nerve)

A

Supplies superior rectus, inferior rectus, inferior oblique, medial recurs

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28
Q

CN IV (trochlear nerve)

A

Supplies superior oblique muscle –> intorts eye

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29
Q

6th nerve palsy

A

Failure of lateral movement- eye is deviated inwards (esotropia) if severe
Horizontal diplopia to affected side

Causes

  • Bilateral = trauma, Wernicke’s encephalopathy, raised ICP, mononeuritis multiplex
  • Unilateral = vascular, tumour (cavernous sinus, retro orbital), demyelination, diabetes, vasculitis/GCA, trauma, idiopathic, raised ICP, paraneoplastic, myasthenia gravis
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30
Q

Causes of nystagmus

A

Jerky

  • Horizontal = vestibular lesion (away from lesion side), cerebellar (towards lesion side), INO (abducting eye)
  • Vertical = brainstem lesion (upbeat = lesion in floor of 4th ventricle vs. downbeat = foramen magnum lesion), toxic (phenytoin, alcohol)

Pendular - retinal, congenital

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31
Q

Supranuclear palsy

A

Loss of vertical upward/downward gaze

  • affects both eyes
  • no diplopia
  • reflex eye movements intact
  • pupils often unequal
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32
Q

Parinaud’s syndrome

A

Loss of vertical upward gaze

Causes

  • Central = pinealoma, MS, vascular lesions
  • Peripheral = trauma, DM, idiopathic, raised ICP
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33
Q

CN V (trigeminal) palsy

A

Causes

  • Central = vascular, tumour, syringobulbia, MS
  • Peripheral = aneurysm, tumour (acoustic neuroma), chronic meningitis
  • Cavernous sinus aneurysm, thrombosis, tumour
  • Other = Sjogren’s, SLE, toxins
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34
Q

CN VII (facial) nerve palsy

A

UMN- contralateral weakness, spares frontalis muscle –> vascular, tumour

LMN- ipsilateral facial weakness of all muscles –> pontine stroke, posterior fossa tumour, Ramsay Hunt, Bell’s palsy, parotid (tumour, sarcoid)

Bilateral = GBS, bilateral parotid disease

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35
Q

Causes of sensorineural deafness

A 
Degeneration
Trauma
Toxic- aspirin, alcohol
Infection
Tumour- acoustic neuroma
Brain stem lesion
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36
Q

Causes of conductive hearing loss

A

Wax
Otitis media
Otosclerosis
Paget’s disease of bone

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37
Q

CN IX (glossopharyngeal) + X (vagus) palsy

A 
Central = vascular (lateral medullary infarction), tumour, syringobulbia, MND
Peripheral = aneurysm, tumour, chronic meningitis, GBS
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38
Q

CN XII (hypoglossal) palsy

A 
UMN = vascular, MND, tumour, MS 
LMN = vascular, MND, syringobulbia, aneurysm, tumour, trauma
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39
Q

Causes of multiple cranial nerve palsies

A

Cavernous sinus lesion
Retroorbital lesion
Paraneoplastic
Nasopharyngeal carcinoma
Chronic meningitis
GBS
Brain stem lesions
Arnold-Chiari malformation
Trauma
Myopathies, NM disease
~~~

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40
Q

Dominant parietal lobe evaluation

A

Acalculia- mental arithmetic
Agraphia- inability to write
Left-right dissociation- put right hand onto left ear
Finger agnosia- inability to name individual fingers

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41
Q

Non-dominant parietal dysfunction

A

Dressing apraxia

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42
Q

Fluent aphasia

A

Receptive, conductive or nominal (Wernicke’s) = temporal gyrus in dominant lobe

  • Unaware of aphasia
  • Naming objects done poorly
  • Difficulty repeating words
  • Impaired comprehension in receptive
  • Difficulty reading in conductive and receptive
  • Impaired writing in conductive (dysgraphia) vs. abnormal content (receptive)
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43
Q

Non-fluent aphasia

A

Expressive (Broca’s) = frontal lobe

  • Aware of aphasia –> frustrated
  • Poor naming of objects
  • Impaired repetition
  • Normal comprehension
  • Dysgraphia can be present
  • Hemiparesis (arm > leg)
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44
Q

Dysarthria

A

Disorder of articulation with no disorder of content of speech

  • consider cerebellar or lower cranial nerve lesion
  • in cerebellar –> slurred, scanning (irregular, staccato)
  • in pseudobulbar palsy –> slow, hesitant, hollow-sounding speech with harsh strained voice
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45
Q

Causes of pronator drift

A

Downwards- UMN weakness (due to muscle weakness)
Upwards- cerebellar lesion (due to hypotonia)
Any direction- posterior column loss (loss of joint position sense)

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46
Q

Muscle power grading

A

0- complete paralysis
1- flicker of contraction
2- movement with no gravity
3- movement against gravity only
4- movement against gravity with some resistance
5- normal power

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47
Q

LMN lesion

A

Weakness
Wasting
Decreased/absent reflexes
Fasciculation

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48
Q

UMN lesion

A

Spasticity
Clonus
Increased reflexes, extensor plantar response
Weakness more marked in UL abductor/extensor muscles and LL flexor muscles

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49
Q

Causes of peripheral neuropathy

A

Axonal (length dependent 75%)- diabetes, compression, alcohol, uraemia, heavy metal toxicity, Vit B12 deficiency, paraneoplastic

Demyelination (20%)- GBS/CIDP, metabolic (leukodystrophies), medications (amiodarone, TNF-antagonists, tacrolimus), infection, hereditary (CMT)

Cell body death (5%)- idiopathic, Sjogren’s, paraneoplastic, drugs (cisplatin, doxorubicin), Fabry’s

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50
Q

Causes of motor neuropathy

A

CIDP
MND- LMN variant
Hereditary motor and sensory neuropathy- Charcot Marie Tooth
Acute intermittent porphyria
DM
Lead poisoning
Multifocal motor neuropathy

51
Q

Causes of sensory neuropathy

A

Diabetes
Carcinoma/paraneoplastic
AIDP
Vasculitic neuropathy
Vitamin B6 intoxication, Vit B12 deficiency
Sjogren’s syndrome
Syphilis

52
Q

Causes of painful peripheral neuropathy

A

DM
Alcohol
Vitamin B12/B1 deficiency
Carcinoma
Porphyria
Arsenic/thallium poisoning

53
Q

Nerve conduction findings for demyelinating disease

A

Velocity <75%
Distal latency >130%
Normal amplitude

54
Q

Nerve conduction findings for axonal disease

A

Amplitude <50%

Velocity >70%

55
Q

Causes of mononeuritis multiplex

A

Separate involvement of >1 peripheral nerve

Acute- diabetes, PAN, SLE, RA
Chronic- joint-deforming arthritis, sarcoidosis, acromegaly, leprosy, carcinoma, idiopathic

56
Q

Causes of thickened nerves

A 
Hereditary motor and sensory neuropathy
Acromegaly
CIDP
Amyloidosis
Leprosy
57
Q

Causes of fasciculation

A

MND
Benign idiopathic fasciculation
Motor root compression
Malignant neuropathy
Spinal muscular atrophy

58
Q

Charcot-Marie-Tooth disease (hereditary motor and sensory neuropathy)

A

Autosomal dominant

Features- pes cavus (short high-arched feet with hammer toes), distal muscle atrophy, absent reflexes, sensory loss in limbs, thickened nerves, optic atrophy, Argyll Robertson pupils

59
Q

Complete lesion of brachial plexus

A

LMN signs affecting whole arm
Sensory loss
Horner’s syndrome (if proximal lesion in lower plexus)

60
Q

Upper trunk lesion (Erb palsy)

A

C5-6
Loss of shoulder movement and elbow flexion
Hand in ‘waiter’s tip’ position
Sensory loss over lateral aspect of arm and forearm, over thumb

61
Q

Lower trunk lesion (Klumpke palsy)

A

C8-T1
Claw hand with paralysis of all intrinsic muscles
Sensory loss along ulnar side of hand and forearm
Horner’s syndrome

62
Q

Cervical rib syndrome

A

Weakness and wasting of small muscles of hand- claw hand
Sensory loss over medial aspect of hand and forearm
Unequal radial pulses and BP
Subclavian bruit and loss of pulse on arm manoeuvring
Palpable cervical rib in neck

63
Q

Radial nerve lesion

A

C5-C8
Wrist and finger drop
Loss of elbow extension (if above spiral groove)
Sensory loss over anatomical snuff box and dorsal radial 3.5 digits

64
Q

Median nerve lesion

A

C6-T1
Hand of benediction- unable to make fist
Weakness of thumb opposition, abduction and flexion
Wasting of thenar eminence
Loss of sensation of lateral 3.5 digits on palmar aspect
Tinel’s/Phalen’s positive

65
Q

Causes of carpal tunnel syndrome

A 
Idiopathic
Pregnancy
Endocrine disease- hypothyroidism, acromegaly
Arthropathy- RA
Trauma/overuse
66
Q

Ulnar nerve lesion

A

C8-T1
Claw hand- unable to open fist
Wasting of hypothenar eminence
Weak finger abduction and adduction, wrist flexion
Froment’s sign- unable to grasp paper between thumb and forefinger
Sensory loss over medial 1.5 digits (dorsal and palmar aspects)

67
Q

Femoral nerve lesion

A 
L2-4
Weakness of knee extension
Slight hip flexion weakness
Preserved adductor strength
Loss of knee jerk
Sensory loss involving inner aspect of thigh and leg
68
Q

Sciatic nerve lesion

A

Weakness of knee flexion
Loss of power of all muscles below knee causing foot drop (cannot stand on toes or heels)
Knee jerk intact
Loss of ankle jerk and plantar response
Sensory loss along posterior thigh and total loss below knee

69
Q

Common peroneal nerve lesion

A

L4-S1
Foot drop, loss of foot eversion
Ankle reflex present
Sensory loss over dorsum of foot

69
Q

Causes of foot drop

A

Common peroneal nerve palsy
Sciatic nerve palsy
Lumbosacral plexus lesion
L4/5 nerve root lesion
Peripheral motor neuropathy
Distal myopathy
MND
Precentral gyrus lesion

70
Q

Spinal cord compression changes

A

LMN signs at level of lesion
UMN signs below lesion

71
Q

Subacute combined degeneration of cord

A

Vitamin B12 deficiency

  • symmetrical posterior column loss –> ataxic gait
  • symmetrical UMN signs in LL with absent ankle reflexes, exaggerated/absent knee jerk
  • peripheral sensory neuropathy
  • optic atrophy
  • dementia
72
Q

Causes of extensor plantar response + absent ankle jerk

A 
Subacute combined degeneration of cord
Conus medullaris lesion
Combination of UMN lesion with cauda equina compression/peripheral neuropathy 
Syphilis
Friedreich's ataxia
DM 
Adrenoleukodystrophy
73
Q

Brown-Sequard syndrome

A

Motor- UMN signs below hemisection on ipsilateral side, LMN signs at level of hemisection on ipsilateral side

Sensory- pain and temperature loss on contralateral side, vibration + proprioception loss on ipsilateral side

Causes- MS, angioma, glioma, trauma, myelitis, post-radiation myelopathy

74
Q

Causes of spinothalamic loss (pain and temperature)

A 
Syringomyelia
Brown-Sequard syndrome
Anterior spinal artery thrombosis
Lateral medullary syndrome
Peripheral neuropathy
75
Q

Cause of dorsal column loss (vibration + proprioception)

A 
Subacute combined degeneration
Brown-Sequard
Spinocerebellar degeneration
MS
Tabes dorsalis
Sensory neuropathy
Peripheral neuropathy
76
Q

Syringomyelia

A

Loss of pain + temperature over neck, shoulder, arms (cape like)
Amyotrophy of arms- weakness, atrophy, areflexia
UMN signs in LL

77
Q

Causes of proximal muscle weakness

A

Myopathy
Neuromuscular junction disorder- MG
Neurogenic- Kugelberg-Welander disease, MND

78
Q

Causes of myopathy

A

Inflammatory- polymyositis/dermato, inclusion body myositis, vasculitis

Endocrine- Cushing’s, thyroid

Metabolic- lipid/glycogen disorder, mitochondrial disorder, rhabdo

Infection- viral (HIV, hepatitis, EBV, influenza)

Toxic- EtoH, cocaine, medications (steroids, statins, fibrates, antimalarials)

Congenital dystrophies- Duchenne’s/Beckers, myotonic, FSH, limb girdle

79
Q

Causes of proximal myopathy + peripheral neuropathy

A

Paraneoplastic syndrome
Alcohol
Connective tissue disease

80
Q

Duchenne’s muscular dystrophy

A

Affects only males
Calves and deltoids are hypertrophied early, weak later
Early proximal weakness
Tendon reflexes preserved in proportion to muscle strength
Severe progressive kyphoscoliosis
Heart disease- dilated CM
CK markedly elevated

Becker’s = similar but later onset, less severe

81
Q

Limb girdle muscular dystrophy

A

Shoulder/pelvic girdle affected
Onset in 3rd decade
Face and heart usually spared

82
Q

Tests for myopathy

A 
CK
EMG
ECG- for Duchennes, myotonic dystrophy
Muscle biopsy
Echocardiogram
83
Q

Types of gait

A

Hemiplegic- foot plantarflexed and leg swung in lateral arc, unilateral, flexed elbow, extended knee/hip
Paraparetic- scissor gait e.g.cerebral palsy
Parkinsonian- stooped position, head down, festination, freezing, shuffling, reduced arm swing, slow turn
Cerebellar- wide-based gait, drunken appearance
Posterior column lesion/sensory- slapping of feet on broad base, positive Romberg’s
Distal weakness/neuropathic- high stepping gait, drop foot, can be bilateral
Proximal weakness/myopathic- waddling gait, positive Trendelenburg

84
Q

Friedreich’s ataxia

A

Young person with

  • cerebellar signs bilaterally
  • posterior column loss in limbs
  • UMN signs in limbs
  • peripheral neuropathy
  • optic atrophy
  • pes cavus
  • cardiomyopathy
  • DM
85
Q

Causes of spastic and ataxia paraparesis

A

UMN + cerebellar signs combined

  • Spinocerebellar degeneration
  • MS
  • Spinocerebellar ataxia
  • Arnold-Chiari malformation
  • Syringomyelia
  • Infarction
86
Q

Causes of Parkinson’s

A 
Idiopathic
Drugs- methyldopa
Post-encephalitis
Toxins
Wilson's disease
87
Q

Types of tremor

A

Parkinsonian- resting, asymmetric

Essential- rapid, accentuated by stress, bilateral and symmetric, affects head/speech
- Causes- meds (amiodarone, steroids, lithium, thyroxine), toxins

Intention (cerebellar)- increases towards target

Cerebellar outflow tract tremor (red nucleus)- abduction-adduction movements of upper limbs with flexion-extension of wrists e.g. MS, brain injury

88
Q

Causes of chorea

A 
Huntington's disease
Sydenham's chorea
Senility
Wilson's disease
Drugs- OCP, phenytoin
Vasculitis
Thyrotoxicosis
Polycythaemia
89
Q

Wasting to abductor pollicis brevis (APB)

A

Median nerve lesion

90
Q

Wasting to abductor digiti minimi and 1st dorsal interossei

A

Ulnar nerve lesion

91
Q

Wasting of 1 hand and weakness of finger extensors/flexors + triceps

A

C7, C8, T1 root or plexus lesion

92
Q

Investigations to request for MND

A

EMG –> evidence of denervation (fasciculations, fibrillation potentials)
NCS –> exclude multifocal motor neuropathy with conduction block
MRI of brain and spinal cord –> should be normal
Modified barium swallow –> check for aspiration
PFTs

93
Q

Hereditary spastic paraparesis

A 
Length-dependent degeneration of corticospinal tract in thoracic spinal cord + dorsal column 
Spastic gait- stiff, feet turned in
UMN signs in LL 
Bilateral LL weakness
Dorsal column impairment 
Bladder dysfunction
Romberg's positive
94
Q

Guillain-Barre syndrome

A

Bilateral symmetric weakness- likely ascending
Absent reflexes
Can affect ocular muscles
Paraesthesias in feet and hands
LP- albuminocytologic dissociation (high protein, normal WCC)

95
Q

Myasthenia gravis

A 
Fatiguable weakness
Ptosis 
Diplopia worse on sustained gaze
Weakness of facial muscles
Myasthenic snarl 
Dysarthria
Bovine cough
Weakness of tongue 
Proximal limb girdle weakness 
Single fibre EMG- abnormal jitter
Repetitive nerve stimulation- decreased response to stimuli
96
Q

Midline cerebellar lesion signs

A 
Affects vermis 
Romberg's positive
Wide-based gait 
Truncal ataxia 
LL dysmetria (abnormal heel shin test)
Horizontal gaze-evoked nystagmus (towards side of lesion) 
Saccadic intrusions 
Vertigo
97
Q

Hemispheric cerebellar lesion signs

A 
Dysdiadochokinesis
UL/LL dysmetria (past pointing) 
Limb ataxia
Intention tremor
Ataxic dysarthria (alternating loudness, fluctuating pitch)
98
Q

Cervical myelopathy signs

A 
LMN signs at level of lesion
UMN signs in LL
Sensory changes
No fasciculations
Check neck for surgical scar
99
Q

Anatomy of LMN

A

Anterior horn cell –> nerve root/nerve –> plexus –> peripheral nerve –> NMJ –> muscle

100
Q

MND signs

A 
Presence of UMN + LMN signs 
Asymmetric limb weakness
Split hand syndrome- lateral aspect more wasted compared to medial
Dysarthria
Dysphagia
Pseudobulbar palsy 
Fasciculations
101
Q

Pseudobulbar palsy

A

Syndrome of bilateral UMN lesions of CN IX, X and XII
Causes- bilateral CVAs in internal capsule, MS, MND, high brainstem tumours, head injury

Increased/normal gag reflex
Spastic tongue
Increased jaw jerk
Slow, hesitant, hollow-sounding speech with harsh strained voice “Donald duck”

102
Q

Bulbar palsy

A

LMN lesion of CN IX, X and XII
Causes- MND, syringobulbia, GBS, brainstem CVA, subacute meningitis

Absent gag reflex
Wasted tongue with fasciculations
Absent/normal jaw jerk
Nasal speech with imprecise articulation

103
Q

Cerebellar speech

A

Slurred, staccato quality

104
Q

If foot drop present, test for inversion/eversion

A

Inversion normal in common peroneal nerve
Inversion absent in L5 radiculopathy
Eversion lost in both

105
Q

If foot drop present, test ankle jerk

A

If absent –> S1 lesion
If present –> common peroneal nerve lesion
If increased –> UMN cause or MND

106
Q

Unilateral cerebellar disease causes

A 
Space occupying lesion- tumour, abscess
Ischaemia
Paraneoplastic syndrome
MS
Trauma
107
Q

Bilateral cerebellar disease causes

A 
Drugs- phenytoin
Friedreich's ataxia
Hypothyroidism
Paraneoplastic syndrome
MS
Trauma
Alcohol
Large space occupying lesion, cerebrovascular disease
108
Q

Causes of pes cavus

A

Longstanding peripheral neuropathy
- Friedreich’s ataxia/spinocerebellar degeneration
- Hereditary motor and sensory neuropathy (CMT)
- Neuropathies in childhood
- Idiopathic

109
Q

Cranial nerve anatomy

A

I, II –> cerebrum
III, IV –> midbrain
V, VI, VII, VIII –> pons
IX, X, XI, XII –> medulla

110
Q

Cranial nerves in cavernous sinus

A

III, IV, VI, first branch of V

111
Q

Multiple sclerosis exam findings

A

Inspect- gait aids
CN exam- optic neuritis (fundoscopy- blurring of optic disc, pallor), RAPD, INO, facial palsy, loss of balance/sensorineural deafness, speech/swallowing difficulty
Cerebellar exam- nystagmus, intention tremor, dysarthria
UL + LL- hypertonia, hyperreflexia, decreased power/spasticity, clonus, abnormal sensation

Ix- MRIB + spinal cord with contrast –> T2 hyperintense white matter plaques, CSF, VEP

112
Q

Causes of INO

A

Ipsilateral loss of adduction + horizontal nystagmus of contralateral eye
= Lesion of medial longitudinal fasciculus
Causes = MS, brainstem lesion/infarct, head trauma

113
Q

Causes of wasted hand

A

Brachial plexus injury
Carpal tunnel syndrome
Peripheral nerve injury
MND- split hand syndrome
Syringomyelia
Congenital- CMT, myotonic dystrophy, inclusion body myositis
Nutritional/disuse

114
Q

Myotonic dystrophy signs

A

Face- frontal baldness, triangular facies, temporalis/masseter wasting, partial ptosis, dysarthria
Neck flexion weakness
Grip myotonia
Difficulty opening eyes after closure
Reduced/absent reflexes
Thenar eminence tap
Forearm muscle wasting
Generalised weakness in arms and legs
Peripheral sensory neuropathy
Foot drop

115
Q

FSH dystrophy signs

A

Expressionless facies
Muscle weakness in face, shoulders and distal legs (tibialis anterior)
No ophthalmoplegia
Winged scapula, difficulty raising arms
Spared wasting of forearms
Protuberant in lower abdomen- Beevor’s sign

116
Q

Cortical signs

A

Speech- aphasia
Focal motor weakness- face/arm (MCA) vs. leg (ACA)
Cortical sensory deficit- stereognosis, 2 point discrimination
Eyes- visuospatial neglect, visual field defect, gaze deviation to affected hemisphere
Higher function- agraphia, apraxia, acalculia

117
Q

Subcortical signs

A

Face-arm-legs equally affected
Pure motor- lacunar lesion
Pure sensory- thalamic lesion
Mixed motor and sensory- thalamus and internal capsule

118
Q

Brainstem lesion

A

INO/nystagmus
Cranial nerve palsies
Ataxia
Altered consciousness
Contralateral motor deficit- crossed limb signs
Autonomic features

119
Q

Horner’s syndrome

A

Ptosis, miosis + anhydrosis

120
Q

Causes of proximal myopathy

A

Endocrine- Cushing’s syndrome, hypothyroidism, acromegaly
Inflammatory- polymyositis, dermatomyositis, scleroderma, MCTD
Drugs- statin, alcohol
NMJ- MG, LEMS
Dystrophies- muscular dystrophy

121
Q

Causes of motor + sensory neuropathy

A

AIDP/CIDP
Vasculitic neuropathy

122
Q

Plexus lesion

A

Ipsilateral
Single limb with LMN signs
Painful
Not attributable to single peripheral nerve/spinal level

123
Q

Conus medullaris lesion

A

Bilateral LL UMN weakness
Bowel/bladder dysfunction

Clinical exam things (7 decks)

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